Persons over the age of 65 are at the greatest risk for adverse effects from benzodiazepine (BZD) drugs. Despite that, this age group remains the highest prescribed group of benzodiazepines. 32% of people over the age of 65 are currently taking a benzodiazepine.
The Screening Tool of Older Person’s Prescriptions (STOPP) and the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults classify benzodiazepines as inappropriate treatment for elderly.
The greater harm to those over the age of 65 who are otherwise living independently is also related to the increased risks to impaired cognition. Harvard recently published a study where it was found that people over the age of 65 who take benzodiazepines longer than 2-4 weeks have an increased risk for Alzheimer’s disease. This risk skyrockets to 83% after six months of use.
Accidents are also a concern to consider before prescribing or taking a benzodiazepines. The usage increases the likelihood of a hip fracture from a fall by 50%-80%. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. Car accidents are also a concern, with the use of benzodiazepines increasing car accident incidents in the elderly.
The risk of suicide in persons over the age of 65 is 4xs greater for those on benzodiazepines. Benzodiazepines had the highest impact of suicidality, beating SSRIS, antipsychotics and other medicines with a black box warning. (As of August 31, 2016, benzodiazepines did receive a black box warning.)
Benzodiazepines are not particularly effective long term for insomnia. Long term studies of benzodiazepines for insomnia show that the beneficial effects of benzodiazepines for insomnia generally wane beyond a month and often before.
Benzodiazepines can also trigger aggressive behavior, especially in the elderly. This in combination with the increased risks for drug interactions, suicide, cognitive impairment, accident and death have caused researchers to consider benzodiazepine use in elderly patients a major public health concern.
Given the availability of options that are far less harmful, benzodiazepines should rarely be considered a first option when it comes to treating people over the age of 65. It is, at minimum, important to explain these risks to the patients, if capable of understanding them, or their caregivers, if they are not able to make the decision on their own. As our life expectancy increases, we have an obligation to ensure that life is not merely longer in duration, but that it is also a better quality of life.